Individual provider Active NPI

Sonia Vargas-Mendoza, DDS

  • General Practice Dentistry
  • Tuscaloosa, AL
National Provider Identifier
1417040163
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
LNO5368 Issued in AL
Practice address
2731 MLK Jr Blvd
Tuscaloosa, AL 35401-5235
Phone
(205) 349-3250
Fax
(205) 345-3993
NPI assigned
Oct 2, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X LNO5368 AL Primary

Addresses

Primary practice location

2731 MLK Jr Blvd
Tuscaloosa, AL 35401-5235

Mailing address

2731 MLK Jr Blvd
Tuscaloosa, AL 35401-5235
Phone (205) 349-3250

Other identifiers 1

IdentifierTypeStateIssuer
51524031OtherALBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LNO5368ALMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417040163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2731 MLK JR BLVD",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354015235",
            "telephone_number": "205-349-3250",
            "fax_number": "205-345-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2731 MLK JR BLVD",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354015235",
            "telephone_number": "205-349-3250",
            "fax_number": "205-345-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARGAS-MENDOZA",
        "first_name": "SONIA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "LNO5368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "51524031",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.